title: Prevalence of corticosteroids use and disease course after initial steroid exposure in ulcerative colitis.
abstract: BACKGROUND
  Limited nationwide data currently exists regarding corticosteroid (CS) use and long-term outcome after CS initiation in ulcerative colitis (UC).
  
  
  OBJECTIVE
  The purpose of this study was to assess CS use prevalence and long-term outcomes after the index CS exposure. Our outcomes of interest were CS use level (reintroduction, dependency, and refractoriness), thiopurine use, and colectomy.
  
  
  METHODS
  Nationwide data was obtained from the Veterans Affairs (VA) healthcare system for the period 2001-2011. Patients with UC were included if they had been diagnosed in the VA system and if they had filled CS for the first time during the observation period. A retrospective cohort design and time-to-event survival analysis was used to track outcomes of interest.
  
  
  RESULTS
  A total of 1,038 newly-diagnosed patients with UC were identified. The prevalence of CS use over the observation period was 45 %. Four hundred sixty-four CS users with median follow-up of 3.4 years were included. Among the included patients, 65 % required CS reintroduction, 38 % were classified as CS dependent, and 11 % were classified as CS refractory mostly within 2 years after the index CS course. Respectively, 8.6 and 38 % had colectomy and received thiopurine. Colectomy and thiopurine use rates varied significantly according to CS use level.
  
  
  CONCLUSIONS
  Approximately half of newly-diagnosed patients with UC required CS. Among CS users, one third of the patients had a sustained response after the initial CS course while two-thirds required further CS therapy. We observed a trend towards higher than previously reported thiopurine use accompanied by marked reduction in colectomy rates.
authors.affiliation: Section of Gastroenterology, Department of Internal Medicine, Southeast Louisiana Veterans Health Care System, New Orleans, LA, USA, nkhan2@tulane.edu.
authors.forename: Nabeel
authors.initials: N
authors.lastname: Khan
authors.forename: Ali
authors.initials: A
authors.lastname: Abbas
authors.forename: Alice
authors.initials: A
authors.lastname: Williamson
authors.forename: Luis
authors.initials: L
authors.lastname: Balart
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000401:mortality / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D016019:Survival Analysis; D017211:Treatment Failure; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*
chemical_list: D000305:Adrenal Cortex Hormones